Form FS-2700-7 Annual Gross Revenue for Purposes of Annual Land Use Fee

FS-2700-7 (XX/202X)

OMB No. 0596-0082

USDA Forest Service			1. Name of Concessioner
ANNUAL GROSS REVENUES FOR PURPOSES OF ANNUAL LAND USE FEE CALCULATION (Reference FSM 2710)			     
			2.
			Year Ended		     		,		20    
I. Description of Sales Per		II. General Ledger Amounts		III. Adjustments +(-)			IV. Sales for Fee Calculation
Permit (a)	General Ledger (b)			Amount (a)		Code (b)
1. Grocery	     	$     		     		  	$	     
	     	     		     		  		     
2. Service food	     	     		     		  		     
	     	     		     		  		     
3. Service car	     	     		     		  		     
	     	     		     		  		     
4. Merchandise	     	     		     		  		     
	     	     		     		  		     
5. Service liquor	     	     		     		  		     
	     	     		     		  		     
6. Outfitting Guiding	     	     		     		  		     
	     	     		     		  		     
7. Service rooms	     	     		     		  		     
	     	     		     		  		     
8. Rentals & services	     	     		     		  		     
	     	     		     		  		     
9. Lifts, tows & ski schools	     	     		     		  		     
	     	     		     		  		     
     	     	     		     		  		     
	     	     		     		  		     
     	     	     		     		  		     
	     	     		     		  		     
     	     	     		     		  		     
	     	     		     		  		     
     	     	     		     		  		     
	     	     		     		  		     
     	     	     		     		  		     
	     	     		     		  		     
10. Totals		$      		$      		  	$	     
11. Commissions and other income (Enter amount from form FS-2700-19, line 7)							$	     
12. Remarks
     
Adjustment Codes A – To account for sub-lessee sales in fee-base and to exclude sub-leasee rent payments B – To gross up to 100% revenue that is booked at less than 100%; for example, vending machines, pool tables, etc... C – To adjust sales from one fee category to the correct category. D – Outright sales of rental or other equipment excluded by the Permit E – The value of Commissions and other income reported on line 11 above. F – The value of unapproved gratuities. (Explain in Remarks, Block 12). G – Other (Explain in Remarks, Block 12).

SAMPLE
USDA Forest Service			1. Name of Concessioner
RECONCILIATION OF SALES FOR FEE CALCULATION (Reference FSM 2710)			SAMPLE
			2.
			Year Ended		     		,		20    
I. Description of Sales Per		II. General Ledger Amounts		III. Adjustments +(-)			IV. Sales for Fee Calculation
Permit (a)	General Ledger (b)			Amount (a)		Code (b)
1. Grocery		$		$			$
2. Service food	Restaurant	1,100,100		/ 240,725		A		1,331,196
				\ (9,629)		C-1
3. Service car	Service station	756,484		(30,259)		F		726,225
4. Merchandise	Store	382,222		/ ( 255)		C		366,585
				\ (15,382)		D
5. Service liquor	Bar	645,878		9,629		C-1		655,507
6. Outfitting Guiding				/ 75,765		B		72,734
				\ (3,031)		A
7. Service rooms	Motel	379,123		(15,165)		C-2		363,958
8. Rentals & services	Ski Shop	758,312		/ (29,532)		A		743,945
				\ 15,165		C-2
9. Lifts, tows & ski schools								-0-
10. Totals		$ 4,022,119		$ 298,549			$	4,260,150
11. Commissions and other income (Enter amount from form FS-2700-19, line 7)							$	2,718
12. Remarks
C-1 Bar sales, adjusted from the Restaurant to Bar C-2 Housekeeping rooms, correct classification to Rentals & Services per permit terms F Gas used by the owner and pumped into affiliated construction company’s trucks
Adjustment Codes A – To account for sub-lessee sales in fee-base and to exclude sub-leasee rent payments B – To gross up to 100% revenue that is booked at less than 100%; for example, vending machines, pool tables, etc... C – To adjust sales from one fee category to the correct category. D – Outright sales of rental or other equipment excluded by the Permit E – The value of Commissions and other income reported on line 11 above. F – The value of unapproved gratuities. (Explain in Remarks, Block 12). G – Other (Explain in Remarks, Block 12).

PAPERWORK REDUCTION ACT STATEMENT

According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to respond to, an information collection request unless it displays a valid Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection request is 0596-0082. Response to this information collection request is required to obtain or retain benefits, specifically, a special use authorization. The authority for this information collection request is the Organic Administration Act,16 U.S.C. 551. The time required to complete this information collection request is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, collecting and maintaining the data needed, and completing and reviewing the information collection request. Send comments regarding this burden estimate or any other aspect of this information collection request, including suggestions for reducing the burden, to Forest Service Information Collections Officer, [email protected], with OMB control number 0596-0082 in the subject line.

PRIVACY ACT STATEMENT

Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act statement serves to inform you of the following concerning the collection of the information on this form.

Purpose:  The Privacy Act of 1974 requires that the Director of Recreation, Heritage, and Volunteer Resources staff and the Director of Lands, Minerals, and Geology Management staff provide the following statements to individuals from whom they request information.

Authority:  Collection of this information solicited on this form is authorized by the Organic Administration Act,16 U.S.C. 551.

Routine Uses:  The information collected will be used by Forest Service officials to ensure that your use of National Forest System lands is administered in accordance with applicable statutes, regulations, and directives. The information collected from you is retained in the Special Uses Data System (SUDS) and is retrieved by the Forest Service create reports for the Agency’s Special Uses Program, generate bills for collection of land use fees for your authorization, monitor compliance with your special use authorization, and other matters pertaining to administration of your special use authorization. SUDS is a component of the Forest Service’s Natural Resources Manager database (NRM). A complete list of the routine uses of NRM can be found in the system of records notice associated with this form, FS-24.

Disclosure:  The submission of this information is required to obtain or retain benefits, specifically, a special use authorization.

NONDISCRIMINATION STATEMENT

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs).  Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency or USDA’s TARGET Center at (202) 720-2600 (voice and TYY) or contact USDA through the Federal Relay Service at (800) 877-8339.  Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all the information requested in the form.  To request a copy of the complaint form, call (866) 632-9992.  Submit the completed form or letter to USDA by (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. 

USDA is an equal opportunity provider, employer, and lender.

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